降钙素原监测对细菌性血流感染类型的诊断预测价值

The predictive value of procalcitonin monitoring in diagnosing the type of bloodstream infection

目的探讨降钙素原监测对细菌性血流感染类型的诊断预测价值。方法回顾性分析2018年1~10月湖北省中医院血培养结果阳性且同时检测血常规、降钙素原(PCT)和C蛋白反应(CRP)的172例细菌性血流感染患者的临床资料,根据血培养结果将患者分为血流感染革兰阳性菌(G+菌)感染组(55例)和血流感染革兰阴性菌(G-菌)感染组(117例)。比较两组患者白细胞计数、中性粒细胞计数、中性粒细胞比例、中性粒细胞淋巴细胞比值、CRP、PCT等炎症指标水平,绘制ROC曲线评价其诊断价值。结果 G+菌感染组患者主要来自急诊科和感染科,以金黄色葡萄球菌感染为主;G-菌感染组患者主要来自感染科和血液内科,以大肠埃希菌感染为主。G-菌感染组患者的PCT水平高于G+菌感染组且差异有统计学意义(P<0.05);当以1.11 ng/mL作为PCT水平的最佳截点值时,其对血流感染类型诊断的敏感性为55.08%,特异度为80.00%。结论 PCT对血流感染患者细菌类型的诊断具有较好的预测价值,且对不同细菌感染类型的检测差异显著。

Objective To explore the predictive value of procalcitonin(PCT) monitoring in diagnosing the type of bloodstream infection. Methods Clinical data of 172 patients with bloodstream infection in Hubei Provincial Hospital of Traditional Chinese Medicine from January to October 2018 were retrospectively analyzed, all patients with positive blood culture and simultaneous detection of blood routine, PCT and C-reaction protein(CRP). According to the results of blood culture, patients were divided into gram-positive bacteria(G+) bacteria infection group(55 cases) and gramnegative bacteria(G-) bacteria infection group(117 cases). The leves of white blood cell count, neutrophil count neutrophil ratio, neutrophil lymphocyte ratio, CRP and PCT were compared between two groups. The ROC curve was used to evaluated the diagnostic value. Results Patients of the G+bacteria infection group were mainly from the department of emergency and infectious disease, the main infection bacterium was Staphylococcus. Patients of the G-bacteria infection group were mainly from the department of infectious disease and hematology, the maininfection bacteria was Escherichia coli. The PCT level of patients in G-bacteria infection group was higher than that of patients in G+bacteria infection group, and the difference was statistically significant(P<0.05). When 1.11 ng/mL was as the optimal cut-off point value, the sensitivity of PCT was 55.08% and the specificity was 80.00%. Conclusion PCT has a good predictive value for the diagnosis of bloodstream infection types, and the detection of different bacterial infection types is significantly different.